1/ In what has 2 be described as a stunning “admission against interest” (lawyer term for someone who speaks against their own interest & is deemed to be highly probative of the truth in evidence), the #TX @AHIPCoverage speaker presented a slide of ED pro fee charges & payments.. 
2/ slide shows that for 5 levels of ED pro fee claims the initial payments average was $142–database of >76K IDR disputes—& the adjudicator’s average award (all 5 ED levels averaged) was $985, that’s 6.94X of the health plan’s initial payment—improved from first 10 months—so …..
3/ what does this say about IDR as the method to resolve $ disputes? 1. Health plans ridiculously low ball initial payments; 2. Physicians are winning more now 16 months in vs. the first 10 months; 3. The average award has increased to nearly 7X from 4.5X initially; 4. Booyah TX!
4/ webcast sponsored by the @NoSurpriseBills coalition—they’re arguments for using the “qualifying payment amount” (QPA) as de facto benchmarking were tantamount to “revisionist history” as Congress rejected the House & Pallon/Alexander benchmarking bills—oh & not word of all…..
5/ record #healthplan profits/stock prices driving the > in premiums—prior contract rates should be discounted as a factor in IDR—rates negotiated by 2 parties—b/c they could be distorted by “surprise billing leverage”—a 1-3 Hospital ED group vs. UHC & >$30+B in operating profit?
• • •
Missing some Tweet in this thread? You can try to
force a refresh
